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Infection in a functioning ventriculoperitoneal shunt treated with intraventricular gentamicin
American Journal of Hospital Pharmacy
|February 1, 1980
Summary
High-dose intraventricular gentamicin sulfate successfully treated a ventriculoperitoneal (VP) shunt infection in an infant. This approach achieved therapeutic cerebrospinal fluid (CSF) levels, offering a potential treatment strategy for similar infections.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Pharmacology
Background:
- Ventriculoperitoneal (VP) shunt infections are a serious complication in hydrocephalus management.
- Enterobacter cloacae and Klebsiella pneumoniae are common causative agents of shunt infections.
- Establishing effective antibiotic concentrations in cerebrospinal fluid (CSF) is crucial for treatment.
Observation:
- A four-month-old infant with hydrocephalus developed a VP shunt infection.
- Initial treatment with intravenous antibiotics was insufficient; subsequent cultures revealed Enterobacter cloacae.
Findings:
- High-dose intraventricular gentamicin sulfate (up to 6 mg/day) combined with intravenous carbenicillin achieved therapeutic cerebrospinal fluid (CSF) gentamicin levels.
- A second infection with Klebsiella pneumoniae was treated with intraventricular gentamicin and intravenous chloramphenicol.
Implications:
- This case demonstrates the potential efficacy of high-dose intraventricular gentamicin for treating VP shunt infections.
- Achieving therapeutic CSF gentamicin levels is possible with adjusted intraventricular dosing in patients with patent VP shunts.